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Wiki Urgent Facility Billing Issue

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kimoverby

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We are a free standing pedatric urgent care facility. The issue that I am having is that Medicaid will not allow me to bill a 99214 on any established patients. They have a restriction on that code for place of service 20. What other cpt code could I use. With all other carriers except Aetna and Cigna we bill either a 99204 or 99214 based on the visit type. With Aetna and Cigna we use the global urgent care code S9083. Any ideas on what I should use to bill Medicaid claims?
 
You bill every visit as a level 4 new or established? There is no way this is correct.
You should bill what is supported by documentation. There may be a high number of 4s but I can't imagine 100% of the visits will support a level 4.

Laura, CPC, CPMA, CEMC
 
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